Chondrodermatitis nodularis chronica helicis: Difference between revisions

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*On gross pathology, CNH looks like any other sore. Microscopically, it shows hyperkeratosis, parakeratosis with epithelial hyperplasia, dermal tissue damage with underlying cartilage destruction and dermal vessel proliferation. <ref name="pmid277231953">{{cite journal| author=Shah S, Fiala KH| title=Chondrodermatitis nodularis helicis: A review of current therapies. | journal=Dermatol Ther | year= 2017 | volume= 30 | issue= 1 | pages=  | pmid=27723195 | doi=10.1111/dth.12434 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27723195  }}</ref><ref name="pmid26925262">{{cite journal| author=Juul Nielsen L, Holkmann Olsen C, Lock-Andersen J| title=Therapeutic Options of Chondrodermatitis Nodularis Helicis. | journal=Plast Surg Int | year= 2016 | volume= 2016 | issue=  | pages= 4340168 | pmid=26925262 | doi=10.1155/2016/4340168 | pmc=4748103 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26925262  }}</ref>
*On gross pathology, CNH looks like any other sore. Microscopically, it shows hyperkeratosis, parakeratosis with epithelial hyperplasia, dermal tissue damage with underlying cartilage destruction and dermal vessel proliferation. <ref name="pmid277231953">{{cite journal| author=Shah S, Fiala KH| title=Chondrodermatitis nodularis helicis: A review of current therapies. | journal=Dermatol Ther | year= 2017 | volume= 30 | issue= 1 | pages=  | pmid=27723195 | doi=10.1111/dth.12434 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27723195  }}</ref><ref name="pmid26925262">{{cite journal| author=Juul Nielsen L, Holkmann Olsen C, Lock-Andersen J| title=Therapeutic Options of Chondrodermatitis Nodularis Helicis. | journal=Plast Surg Int | year= 2016 | volume= 2016 | issue=  | pages= 4340168 | pmid=26925262 | doi=10.1155/2016/4340168 | pmc=4748103 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26925262  }}</ref>


== Causes[edit | edit source] ==
==Causes[edit | edit source]==


* Chondrodermatitis nodularis chronica helicis may be caused due to chronic pressure or trauma or anatomic features or temperature changes or actinic damage to the ear. Prolonged pressure seemed the most commonly reported cause. Sleeping on the one side can cause this pressure.
*Chondrodermatitis nodularis chronica helicis may be caused due to chronic pressure or trauma or anatomic features or temperature changes or actinic damage to the ear. Prolonged pressure seemed the most commonly reported cause. Sleeping on the one side can cause this pressure.


* Other causes can be continuous use of headphones/ ear phones/ cell phones, hearing aids, or can be idiopathic. There are some theories on association with autoimmune disorders and connective tissue diseases like scleroderma, autoimmune thyroiditis, lupus erythematosus, or dermatomyositis. <ref name="pmid299261642">{{cite journal| author=García-García B, Munguía-Calzada P, Aubán-Pariente J, Junceda-Antuña S, Zaballos P, Argenziano G | display-authors=etal| title=Dermoscopy of chondrodermatitis nodularis helicis. | journal=Arch Dermatol Res | year= 2018 | volume= 310 | issue= 7 | pages= 551-560 | pmid=29926164 | doi=10.1007/s00403-018-1844-6 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29926164  }}</ref><ref name="pmidhttps://www.ncbi.nlm.nih.gov/pubmed/29805936">{{cite journal| author=Salah H, Urso B, Khachemoune A| title=Review of the Etiopathogenesis and Management Options of Chondrodermatitis Nodularis Chronica Helicis. | journal=Cureus | year= 2018 | volume= 10 | issue= 3 | pages= e2367 | pmid=https://www.ncbi.nlm.nih.gov/pubmed/29805936 | doi=10.7759/cureus.2367 | pmc=5969795 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29805936  }}</ref><ref name="pmid282174743">{{cite journal| author=Kumar P, Barkat R| title=Chondrodermatitis nodularis chronica helicis. | journal=Indian Dermatol Online J | year= 2017 | volume= 8 | issue= 1 | pages= 48-49 | pmid=28217474 | doi=10.4103/2229-5178.198767 | pmc=5297272 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28217474  }}</ref><ref name="pmid277231954">{{cite journal| author=Shah S, Fiala KH| title=Chondrodermatitis nodularis helicis: A review of current therapies. | journal=Dermatol Ther | year= 2017 | volume= 30 | issue= 1 | pages=  | pmid=27723195 | doi=10.1111/dth.12434 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27723195  }}</ref>
*Other causes can be continuous use of headphones/ ear phones/ cell phones, hearing aids, or can be idiopathic. There are some theories on association with autoimmune disorders and connective tissue diseases like scleroderma, autoimmune thyroiditis, lupus erythematosus, or dermatomyositis. <ref name="pmid299261642">{{cite journal| author=García-García B, Munguía-Calzada P, Aubán-Pariente J, Junceda-Antuña S, Zaballos P, Argenziano G | display-authors=etal| title=Dermoscopy of chondrodermatitis nodularis helicis. | journal=Arch Dermatol Res | year= 2018 | volume= 310 | issue= 7 | pages= 551-560 | pmid=29926164 | doi=10.1007/s00403-018-1844-6 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29926164  }}</ref><ref name="pmidhttps://www.ncbi.nlm.nih.gov/pubmed/29805936">{{cite journal| author=Salah H, Urso B, Khachemoune A| title=Review of the Etiopathogenesis and Management Options of Chondrodermatitis Nodularis Chronica Helicis. | journal=Cureus | year= 2018 | volume= 10 | issue= 3 | pages= e2367 | pmid=https://www.ncbi.nlm.nih.gov/pubmed/29805936 | doi=10.7759/cureus.2367 | pmc=5969795 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29805936  }}</ref><ref name="pmid282174743">{{cite journal| author=Kumar P, Barkat R| title=Chondrodermatitis nodularis chronica helicis. | journal=Indian Dermatol Online J | year= 2017 | volume= 8 | issue= 1 | pages= 48-49 | pmid=28217474 | doi=10.4103/2229-5178.198767 | pmc=5297272 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28217474  }}</ref><ref name="pmid277231954">{{cite journal| author=Shah S, Fiala KH| title=Chondrodermatitis nodularis helicis: A review of current therapies. | journal=Dermatol Ther | year= 2017 | volume= 30 | issue= 1 | pages=  | pmid=27723195 | doi=10.1111/dth.12434 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27723195  }}</ref>
 
<br />
 
== Differentiating [disease name] from other Diseases[edit | edit source] ==
 
* Chondrodermatitis nodularis chronica helicis must be differentiated from other diseases that cause a bump on the ear, such as:
 
:* Actinic Keratosis
:* Basal cell carcinoma
:* Keratoacanthoma
:* Squamous cell carcinoma
:* Gouty tophi
 
== Epidemiology and Demographics[edit | edit source] ==
 
* The disease is much common than it is reported.
* CNH is seen mostly in elderly men, but may occur with women and children too.
* CNH is seen mostly in fair skin individuals who are more exposed to sun, but can occur with any ethnicity.
 
=== Age[edit | edit source] ===
 
* Patients of all age groups may develop [disease name].
 
* [Disease name] is more commonly observed among patients aged [age range] years old.
* [Disease name] is more commonly observed among [elderly patients/young patients/children].
 
=== Gender[edit | edit source] ===
 
* [Disease name] affects men and women equally.
 
* [Gender 1] are more commonly affected with [disease name] than [gender 2].
* The [gender 1] to [Gender 2] ratio is approximately [number > 1] to 1.
 
=== Race[edit | edit source] ===
 
* There is no racial predilection for [disease name].
 
* [Disease name] usually affects individuals of the [race 1] race.
* [Race 2] individuals are less likely to develop [disease name].
 
== Risk Factors[edit | edit source] ==
 
* Common risk factors in the development of [disease name] are [risk factor 1], [risk factor 2], [risk factor 3], and [risk factor 4].
 
== Natural History, Complications and Prognosis[edit | edit source] ==
 
* The majority of patients with [disease name] remain asymptomatic for [duration/years].
* Early clinical features include [manifestation 1], [manifestation 2], and [manifestation 3].
* If left untreated, [#%] of patients with [disease name] may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].
* Common complications of [disease name] include [complication 1], [complication 2], and [complication 3].
* Prognosis is generally [excellent/good/poor], and the [1/5/10­year mortality/survival rate] of patients with [disease name] is approximately [#%].


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Revision as of 16:57, 28 July 2021

File:Chondrodermatitis.jpg
Chondrodermatitis helicis nodularis in a 67-year-old man.


_ Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Karnik Raju Paila Bangaru, M.B.B.S.[2] Kiran Singh, M.D. [3]

Synonyms and keywords:Chondrodermatitis nodularis helicis, winkler disease, ear pressure sore

Overview

Chondrodermatitis nodularis chronica helicis (also known as "Chondrodermatitis nodularis helicis"[1]:782) (CNH) is a small, nodular, tender, chronic inflammatory lesion occurring on the helix of the ear, occurring most often in men.[2]:610


Historical Perspective[edit | edit source]

  • Chondrodermatitis nodularis chronica helicis was first discovered by Max Winkler, a dermatologist, in 1915, in a paper titled Knötchenförmige Erkrankung am Helix . [3][4]
  • in 1925, Foerster further developed the clinical, microscopic and treatment options for CNH.

Pathophysiology

  • The pathophysiology of Chondrodermatitis nodularis chronica helicis remains unclear. It may be due to an inflammatory condition from chronic pressure on ear pinna.
  • CNH is seen mostly in elderly men. There are few cases seen in women and young, especially when CNH is associated with autoimmune or connective tissue disorders. [5][6][7][8]
  • The anatomy of ear pinna can contribute to the pathophysiology of CNH. The pinna has limited blood supply and little subcutaneous tissue, which easily lead to formation of sore with pressure or trauma or cold temperature. [9]
  • In 2009, Perichondrium vasculitis theory explained above anatomical features. Because of the vasculature and subcutaneous tissue padding limitations, there is easy development of ischemia and necrosis of underlying cartilage, causing a severe inflammatory condition, leading to CNH. [10][11]
  • On gross pathology, CNH looks like any other sore. Microscopically, it shows hyperkeratosis, parakeratosis with epithelial hyperplasia, dermal tissue damage with underlying cartilage destruction and dermal vessel proliferation. [12][13]

Causes[edit | edit source]

  • Chondrodermatitis nodularis chronica helicis may be caused due to chronic pressure or trauma or anatomic features or temperature changes or actinic damage to the ear. Prolonged pressure seemed the most commonly reported cause. Sleeping on the one side can cause this pressure.
  • Other causes can be continuous use of headphones/ ear phones/ cell phones, hearing aids, or can be idiopathic. There are some theories on association with autoimmune disorders and connective tissue diseases like scleroderma, autoimmune thyroiditis, lupus erythematosus, or dermatomyositis. [14][15][16][17]


Differentiating [disease name] from other Diseases[edit | edit source]

  • Chondrodermatitis nodularis chronica helicis must be differentiated from other diseases that cause a bump on the ear, such as:
  • Actinic Keratosis
  • Basal cell carcinoma
  • Keratoacanthoma
  • Squamous cell carcinoma
  • Gouty tophi

Epidemiology and Demographics[edit | edit source]

  • The disease is much common than it is reported.
  • CNH is seen mostly in elderly men, but may occur with women and children too.
  • CNH is seen mostly in fair skin individuals who are more exposed to sun, but can occur with any ethnicity.

Age[edit | edit source]

  • Patients of all age groups may develop [disease name].
  • [Disease name] is more commonly observed among patients aged [age range] years old.
  • [Disease name] is more commonly observed among [elderly patients/young patients/children].

Gender[edit | edit source]

  • [Disease name] affects men and women equally.
  • [Gender 1] are more commonly affected with [disease name] than [gender 2].
  • The [gender 1] to [Gender 2] ratio is approximately [number > 1] to 1.

Race[edit | edit source]

  • There is no racial predilection for [disease name].
  • [Disease name] usually affects individuals of the [race 1] race.
  • [Race 2] individuals are less likely to develop [disease name].

Risk Factors[edit | edit source]

  • Common risk factors in the development of [disease name] are [risk factor 1], [risk factor 2], [risk factor 3], and [risk factor 4].

Natural History, Complications and Prognosis[edit | edit source]

  • The majority of patients with [disease name] remain asymptomatic for [duration/years].
  • Early clinical features include [manifestation 1], [manifestation 2], and [manifestation 3].
  • If left untreated, [#%] of patients with [disease name] may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].
  • Common complications of [disease name] include [complication 1], [complication 2], and [complication 3].
  • Prognosis is generally [excellent/good/poor], and the [1/5/10­year mortality/survival rate] of patients with [disease name] is approximately [#%].


Diagnosis

Physical Examination

Skin

Ear

References

  1. ↑ Freedberg, et al. (2003). Fitzpatrick's Dermatology in General Medicine. (6th ed.). McGraw-Hill. ISBN 0-07-138076-0.
  2. ↑ James, William; Berger, Timothy; Elston, Dirk (2005). Andrews' Diseases of the Skin: Clinical Dermatology. (10th ed.). Saunders. ISBN 0-7216-2921-0.
  3. ↑ Wagner G, Liefeith J, Sachse MM (2011). "Clinical appearance, differential diagnoses and therapeutical options of chondrodermatitis nodularis chronica helicis Winkler". J Dtsch Dermatol Ges. 9 (4): 287–91. doi:10.1111/j.1610-0387.2011.07601.x. PMID 21276202.
  4. ↑ Kechichian E, Jabbour S, Haber R, Abdelmassih Y, Tomb R (2016). "Management of Chondrodermatitis Nodularis Helicis: A Systematic Review and Treatment Algorithm". Dermatol Surg. 42 (10): 1125–34. doi:10.1097/DSS.0000000000000817. PMID 27399947.
  5. ↑ García-García B, Munguía-Calzada P, Aubán-Pariente J, Junceda-Antuña S, Zaballos P, Argenziano G; et al. (2018). "Dermoscopy of chondrodermatitis nodularis helicis". Arch Dermatol Res. 310 (7): 551–560. doi:10.1007/s00403-018-1844-6. PMID 29926164.
  6. ↑ Salah H, Urso B, Khachemoune A (2018). "Review of the Etiopathogenesis and Management Options of Chondrodermatitis Nodularis Chronica Helicis". Cureus. 10 (3): e2367. doi:10.7759/cureus.2367. PMC 5969795. PMID 29805936.
  7. ↑ Kumar P, Barkat R (2017). "Chondrodermatitis nodularis chronica helicis". Indian Dermatol Online J. 8 (1): 48–49. doi:10.4103/2229-5178.198767. PMC 5297272. PMID 28217474.
  8. ↑ Shah S, Fiala KH (2017). "Chondrodermatitis nodularis helicis: A review of current therapies". Dermatol Ther. 30 (1). doi:10.1111/dth.12434. PMID 27723195.
  9. ↑ Elsensohn A, Getty S, Shiu J, de Feraudy S (2018). "Intradermal Proliferative Fasciitis Occurring With Chondrodermatitis Nodularis Helicis". Am J Dermatopathol. 40 (2): 139–141. doi:10.1097/DAD.0000000000001027. PMC 6075668. PMID 29210713.
  10. ↑ Kumar P, Barkat R (2017). "Chondrodermatitis nodularis chronica helicis". Indian Dermatol Online J. 8 (1): 48–49. doi:10.4103/2229-5178.198767. PMC 5297272. PMID 28217474.
  11. ↑ Shah S, Fiala KH (2017). "Chondrodermatitis nodularis helicis: A review of current therapies". Dermatol Ther. 30 (1). doi:10.1111/dth.12434. PMID 27723195.
  12. ↑ Shah S, Fiala KH (2017). "Chondrodermatitis nodularis helicis: A review of current therapies". Dermatol Ther. 30 (1). doi:10.1111/dth.12434. PMID 27723195.
  13. ↑ Juul Nielsen L, Holkmann Olsen C, Lock-Andersen J (2016). "Therapeutic Options of Chondrodermatitis Nodularis Helicis". Plast Surg Int. 2016: 4340168. doi:10.1155/2016/4340168. PMC 4748103. PMID 26925262.
  14. ↑ García-García B, Munguía-Calzada P, Aubán-Pariente J, Junceda-Antuña S, Zaballos P, Argenziano G; et al. (2018). "Dermoscopy of chondrodermatitis nodularis helicis". Arch Dermatol Res. 310 (7): 551–560. doi:10.1007/s00403-018-1844-6. PMID 29926164.
  15. ↑ Salah H, Urso B, Khachemoune A (2018). "Review of the Etiopathogenesis and Management Options of Chondrodermatitis Nodularis Chronica Helicis". Cureus. 10 (3): e2367. doi:10.7759/cureus.2367. PMC 5969795. PMID https://www.ncbi.nlm.nih.gov/pubmed/29805936 Check |pmid= value (help).
  16. ↑ Kumar P, Barkat R (2017). "Chondrodermatitis nodularis chronica helicis". Indian Dermatol Online J. 8 (1): 48–49. doi:10.4103/2229-5178.198767. PMC 5297272. PMID 28217474.
  17. ↑ Shah S, Fiala KH (2017). "Chondrodermatitis nodularis helicis: A review of current therapies". Dermatol Ther. 30 (1). doi:10.1111/dth.12434. PMID 27723195.
  18. ↑ 18.0 18.1 18.2 18.3 18.4 18.5 18.6 18.7 18.8 18.9 "Dermatology Atlas".


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